MeaningPatients undergoing elective surgery with in-network primary surgeons and facilities may be at risk of receiving out-of-network bills.

Abstract

ImportancePrivately insured patients who receive care from in-network physicians may receive unexpected out-of-network bills (“surprise bills”) from out-of-network clinicians they did not choose. In elective surgery, this can occur if patients choose in-network surgeons and hospitals but receive out-of-network bills from other involved clinicians.

ObjectiveTo evaluate out-of-network billing across common elective operations performed with in-network primary surgeons and facilities.

Main Outcomes and MeasuresThe primary outcome was the proportion of episodes with out-of-network bills. The secondary outcome was the estimated potential balance bill associated with out-of-network bills from each surgical procedure, calculated as total out-of-network charges less the typical in-network price for the same service.

Conclusions and RelevanceIn this retrospective analysis of commercially insured patients who had undergone elective surgery at in-network facilities with in-network primary surgeons, a substantial proportion of operations were associated with out-of-network bills.